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Some Kentucky health advocates are raising concerns about reports of children and possibly others, such as pregnant women, being wrongly denied routine dental care in the days after a judge halted the implementation of Kentucky HEALTH, the state’s Section 1115 Medicaid waiver.

But the Cabinet for Health and Family Services (CHFS) says those two groups “should continue to receive all services, including vision and dental” and that it plans to work with providers to make sure they properly understand the eligibility screens on their computers and how make correct interpretations about eligibility.

“Dozens of provider trainings were conducted throughout Kentucky, which included training on how to read the new screens, starting July 1,” the Cabinet said in a statement Friday afternoon. “There were, however, minor changes to language and how information was displayed since those trainings in response to the June 29 court ruling. CHFS has taken feedback from providers on how to better display the information and make it easier to understand.”

It also reiiterated that the Kentucky Department for Medicaid Services “has not changed any policies relating to the eligibility of pregnant women and children” and noted that the state had received reports that “some providers have misinterpreted earlier training and guidance.”

“We regret any confusion that caused Kentuckians on Medicaid to not receive the care for which they were eligible,” CHFS Deputy Secretary Kristi Putnam said in the news release.

The Friday statement followed an outcry earlier in the week by groups, such as the Kentucky Oral Health Coalition, which said it had heard directly from multiple dental providers across the state that “Medicaid changes over the past few days have resulted in the denial of routine dental care of eligible children and pregnant women.”

The coalition, whose membership includes health providers, students, managed care organizations, health departments and others, also noted, “Kentucky has long struggled with oral health challenges and we can’t afford to let errors turn children and pregnant women away from receiving important care.”

Kentucky Youth Advocates, via a Thursday statement by executive director Terry Brooks, called for Gov. Matt Bevin’s administration to “immediately commit to reimbursing and notifying providers for all children, pregnant women, and former foster youth who had Medicaid coverage as of June 30, 2018,” if affected.

Earlier in the week, the state had drawn criticism for the cutting of dental and vision coverage for eligible Medicaid expansion adults in the wake of a judge’s ruling on Kentucky HEALTH. The Bevin administration program was set to kick off last Sunday but got halted by U.S. District Court Judge James Boasberg over concerns about how the Medicaid waiver was approved by the Trump administration.

Meanwhile, for patients, said Jennifer Hasch, dental services manager at the Shawnee Christian Healthcare Center, “there’s just a lot of uncertainty and anxiousness around it all,” adding that people from the neighborhood had stopped in to have their benefits checked.

Boasberg decided last Friday that Kentucky HEALTH, which was to include a work or “community engagement” requirement, premiums and lockouts, warrants further review by the U.S. Department of Health and Human Services. In response, the state posted information online saying that people who would have had access to a Kentucky Health feature called My Rewards to cover their vision and dental benefits would no longer have those benefits.

My Rewards was to include a health savings account for the eligible Medicaid expansion adults to earn virtual dollars, through things like taking online classes and getting health screenings, to pay for routine dental and vision benefits instead of getting that coverage automatically.

Instead of continuing coverage as it had been before Kentucky HEALTH, the state cut off those benefits, blaming the judge’s decision and sparking the ire of some Democrats and consumer advocates about the speed and potential impact of the move on affected adults.

Terry Brooks, executive director of Kentucky Youth Advocates

Similar concern erupted in the media and on social media channels over children’s benefits. In its Thursday statement, Kentucky Youth Advocates said, “We have heard from numerous dental providers across the state around these seemingly unintended denials.”

Given past efforts by Bevin and others in his administration to protect vulnerable populations, KYA is “surprised and disappointed to learn that, as a result of the administration’s response to the Medicaid ruling on Kentucky HEALTH, Medicaid-eligible children and pregnant women are experiencing the denial of routine dental care.”

KYA also noted that it was concerned about former foster youth, saying, “we hope that the administration is monitoring whether their coverage is being impacted.”

The University of Louisville said through a spokeswoman that its dental school “has seen a couple of instances where pediatric patients who were previously covered showed up as denied.”

However, in its Thursday statement, the Cabinet said: “We are not aware of any children or pregnant women being denied vision or dental coverage because of a change made to their eligibility within the system. According to system checks that we’ve made, and to providers we have spoken to Tuesday and today (Thursday), eligibility is being correctly applied for pregnant women and children. We are working to provide more communication to supplement providers’ training, and to make sure providers understand the new look of some eligibility screens on their computer system.”

The Cabinet also initially said, “These statements by advocacy/interest groups and others are perpetuating misinformation, and causing confusion among individuals calling to check on eligibility for themselves and/or their children.”

The state suggested that people who think they were “incorrectly identified” call 800-635-2570 for assistance.

Friday, the Cabinet announced that the Department for Medicaid Services is distributing an updated resource guide for dental and vision providers through managed care organizations, provider groups, and the internet. Also, there is more general information about various aspects of Kentucky HEALTH, including some codes for dental and vision services and a status update, at the main website: https://kentuckyhealth.ky.gov.

Hasch said that, as of Thursday, the Shawnee Christian Healthcare Center hadn’t had any children’s eligibility issues since they’d been seeing adults in recent days. But other things had gone awry.

When checking to see whether people were eligible for coverage, “we’ve seen several times in the last few days what is on say, the MCO (managed care organization) website is not what’s on the Kentucky Medicaid website,” she said.

Also, the center noticed that a disabled patient was showing up on the state’s site as having no dental coverage, although that shouldn’t have been the case, she said.

The Kentucky Dental Association released a statement Thursday saying: “We are disappointed by the removal of dental benefits on July 1 due to the court ruling. Our continued goal is to work with our member dentists and patients to achieve optimal dental health in all populations. The Kentucky Dental Association remains committed to advocate for the inclusiveness of dental benefits in Medicaid and to partner with the administration to restore those benefits as soon as possible.”

As for youths who may have been denied coverage, the association said: “We have heard these reports from members and in the media. This is a question we still need answered from CHFS,” meaning the Kentucky Cabinet for Health and Family Services.

Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.


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